hypnosis and communication for the management of pain dr...

Hypnosis and Communication for the Management of Pain

Dr Allan M CynaWomen’s & Children’s Hospital, Adelaide, Australia

20th September 20191000-1300 Workshop 1

Hypnosis and Communication for the Management of PainDisclosures

• The subconscious affects everything we perceive and do

• No Financial or other known disclosures

Hypnosis for pain relief

• GREAT and LAURS

• Arm Anaesthesia

• Lived in imagination

• Body dissociation

• Ideomotors and hypnoanalysis

• Hypnosis and Anaesthesia

• Switch-wire imagery

What is Hypnosis?

Hypnosis for pain reliefBasic Principles

Conscious

Subconscious

Being in “two minds”

Being “besides oneself”

“Out of body experiences”

“Daydreaming”

“Tuning out”

Hypnosis and Pain managementEveryday Subconscious experiences

• Being in “two minds”

• Being “besides oneself”

• “Out of body experiences”

• “Daydreaming”

• “Tuning out”

Hypnosis and Pain managementThe pain in the main is plainly in the brain!

Hypnosis and Pain managementWhy do we have a subconscious?

Is their an evolutionary basis?

Dissociation

Immuno-neurobiology

Haemostasis

Hypnosis for pain reliefWhy do we have a subconscious?

Is their an evolutionary basis?

Dissociation / Catalepsy

Immuno-neurobiology

Haemostasis

Meaning & Metaphor

Hypnosis and Pain managementWhy bother? The patient’s reality

• Helplessness and dependence

• Loss of control

• Patients may view themselves as• victims to their illness in a hostile system

• Recipients of incomprehensive technology

• Passive

• Voiceless

Hypnosis for pain relief - Goals

Clinician

•Safety• Comfort • Control

• Choices

Patient

•Control• Choices• Comfort

• Safety

Hypnosis in Pain ManagementWhy patients with pain are special

• Overwhelmed by sensory overload

• Internal absorption

• Little reality testing

• Responsive to authority figures

• Frequently respond subconsciously

Hypnosis and pain relief• Pain management mythology

• Why do we have pain?

• Characteristics of pain patients

• Applications• Acute

• Chronic

• Techniques

Pain mythology

• Chronic pain is forever

• Chronic pain patients just have to learn to live with it

• The pain journey is a helpful metaphor

• I’ve tried everything……

• Best to warn the patient that its going to hurt or sting!

Hypnosis : The ideal treatment for pain

• Facilitates cooperation

• Provides analgesia / anxiolysis in seconds or minutes

• Easy to administer

• Rapid onset

• Inexpensive

• Minimal side effects

• Empowers the patient

Practical hypnosis in relieving painSupporting Evidence

• Egbert et al. Reduction of postoperative pain by encouragement and instruction of patients. New Engl J Med 1964;270:825-27

• Lang EV et al. Can words hurt? Patient-provider interactions during invasive procedures. Pain 2005;114:303-9

• Dutt- Gupta et al. The effects of communication on pain. BJA Dec 2007

Hypnosis and pain reliefWhy patients with pain are special

• Overwhelmed by sensory overload

• Internal absorption

• Little reality testing

• Responsive to authority figures

• Frequently respond subconsciously

Hypnosis for pain reliefQuestions / Statements

• What• colour is the pain?

• shape is it?

• texture?

• does it sound like?

• does it taste / smell like?

• Tell me about the pain when at it’s least worse?

• Crying ………is it useful?


A GREAT way to communicate hypnotically

•Greeting

•Rapport

•Expectations

•Addressing concerns

•Tacit agreement

The GREAT acronym - Greeting

• What do you like being called?

• What do your friends call you?

• Is it Ok if I call you …….?

Words that hurt! words that help!

The GREAT acronym - Rapport

• L

• A

• U

• R

• S

GREAT Expectations

• What is the goal of the interaction?

•Expectations of both staff and patients

• Mutual decision making

GREAT Addressing concerns

The GREAT –Tacit agreement

1. Tacit agreement

2. Thanking the patient

3. Reinforcing success

4. Terminating the interaction

Hypnosis for pain reliefThe L.A.U.R.S. of hypnotic communication

• Listening

• Acceptance

• Utilisation

• Reframing

• Suggestion

Words that hurt! words that help! Reflective listening and checking in!

Did you hear what was said?

Did you understand what was meant?

Does the patient know:

- they have been heard?

- they have been understood?

Hypnosis for pain reliefThe 75 essential steps for Effective Hypnosis

Listen Listen Listen- Listen- Listen - Listen- Listen- Listen ListenListen- Listen- Listen- Listen- Listen- Listen- Listen- Listen-Listen Listen Listen Listen- Listen- Listen - Listen- Listen- Listen Listen Listen- Listen- Listen- Listen- Listen- Listen- Listen-Listen- Listen Listen Listen Listen- Listen- Listen - Listen-Listen- Listen Listen Listen- Listen- Listen- Listen- Listen-Listen- Listen- Listen- Listen Listen Listen Listen- Listen- Listen - Listen- Listen- Listen Listen Listen- Listen- Listen- Listen-

Listen- Listen- Listen- Listen- Listen Listen, Listen, Listen

Hypnosis for pain reliefReflective listening and checking in!

Hypnosis for Pain reliefLAURS AcceptanceAppreciating different realities

1. The first reality

2. The second reality

3. The third reality


LAURS Utilisation

• Favourite food & Drink ?antiemesis

• Favourite place


• “Let me know when you have pain!”

• “This is going to sting a little!”

• “Try not to move!”

• “We will give you something for nausea”

• “Here is some medication to stop the itching!”

• This may hurt!


LAURS Reframing pain perceptions and behaviours

LAURS Suggestion

• Direct / Indirect - FRC

• Positive / Negative

• Truisms and ‘yes’ sets

• Reversed effect

• Double binds

• Starting vs Finishing

Hypnosis for pain reliefSuggestions of death!

• “We’re just going to check the ID band one last time”

• “The anaesthetist will put you to sleep!”

• “Would you like to kiss your child goodbye?”

Hypnosis for pain relief 2 sides of the same coin?

•Placebo

•Nocebo

Hypnosis for pain relief Effects of negative suggestion!


LAURS in an emergency

“If you come near me with that needle, I’ll die!”

“Are you trying to do a hypnotic arm anaesthesia?

“I can’t listen to you!”

Hypnosis and CommunicationThe L.A.U.R.S. of hypnotic communication

• Listening

• Acceptance

• Utilisation

• Reframing

• Suggestion

Hypnosis and pain reliefTechniques

• Arm Anaesthesia

• Application of body dissociation

• Believed in imagination

• Switch wire imagery

TRY

Pain

Apologising

Worry

Not

Hypnosis for pain reliefSabotage words


Believed in Imagination

Teaching and learning Self hypnosis

Hypnosis and Communication for the Anaesthetist Subconscious language and believed in imagination• Seeding suggestions and asking permission

• In a moment but not yet…….”

• Ask detailed questions

• Use all senses

• Talk as if the patient is there

• Repeat suggestion in different ways

Hypnosis and Communication for the Anaesthetist Setting up Ideomotor finger signals

“I am going to call the index finger the ‘YES Finger’I am going to call the middle finger the ‘NO Finger’”

“Imagine the word ‘YES’ and when you are imagining the word ‘YES’ allow the ‘Yes Finger’ to lift up and let me know”

”When you are imagining the word ‘No’ Allow the ‘NO Finger’ to lift up and let me know”

Hypnosis 4 kids - Practical strategies

• Asking permission

• Pretending

• As if

• Believed in imagination

• Suggestion

• Finishing versus starting

• Switch wire imagery

Managing needle phobia and drips generally

• Following Listening and Acceptance…..

• Can I show you some tricks that can help?

• Is it OK to

– stand next to you?

– look at the arm?

– put this tourniquet on, so the arm can feel sleepy?

– tap the hand so it feels sleepier than it is already?

– wipe the sensation away with the antiseptic?

– Finish?

Hypnosis and Pain Suggestions for Anaesthesia & Control

• Feel the arm relax….

• You don’t have to try

• As you focus…….

• As the tourniquet is placed

feel the arm go tingly heavy

and sleepy

Hypnosis in Paediatrics and Obstetrics

“Whether you think you can or whether you think you can’t – You are probably right!”

Adapted from Henry Ford

• Appreciate subconscious responses

• Believe that patients can do more than..

• Choice and Control are important

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hypnosis and communication for the management of pain dr...

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